Halpern Michael T, McCabe Mary S, Burg Mary Ann
From the Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ; Memorial Sloan Kettering Cancer Center, New York, NY; University of Central Florida School of Social Work, Orlando, FL.
Am Soc Clin Oncol Educ Book. 2016;35:231-9. doi: 10.1200/EDBK_156039.
Although the number of long-term cancer survivors has increased substantially over past years, the journey of survivorship does not always include high-quality, patient-centered care. A variety of survivorship care models have evolved based on who provides this care, the survivor population, the site of care, and/or the capacity for delivering specific services. Other areas of survivorship care being explored include how long follow-up care is needed, application of a risk-based approach to survivorship care, and the role of the survivor in his or her own recovery. However, there is little evidence indicating whether any models improve clinical or patient-reported outcomes. A newer focus in survivorship care has included assessment of potential disparities; the sociodemographic characteristics of population subgroups associated with barriers to receiving high-quality cancer treatment may also affect the survivorship period. Developing policies and programs to address disparities in survivorship care is not simple, and examining how financial hardship affects cancer outcomes, reducing economic barriers to care, and increasing incorporation of patient-centered strategies may be important components. Here too, there is little evidence regarding the best strategies to address these disparities. Barriers to providing high-quality, patient-centered survivorship care include lack of evidence, lack of a trained survivorship workforce, lack of reimbursement structures/insurance coverage, and lack of a health care system that reduces fragmented care. Future research needs to focus on developing a survivorship care evidence base, exploring strategies to facilitate provision of survivorship care, and disseminating best survivorship care practices to diverse and international audiences.
尽管在过去几年中，长期癌症幸存者的数量大幅增加，但生存之旅并不总是包含高质量的、以患者为中心的护理。基于提供护理的人员、幸存者群体、护理地点和/或提供特定服务的能力，已经演变出了多种生存护理模式。正在探索的生存护理的其他领域包括需要多长时间的后续护理、基于风险的生存护理方法的应用以及幸存者在其自身康复中的作用。然而，几乎没有证据表明任何模式能改善临床或患者报告的结果。生存护理中一个新的重点包括对潜在差异的评估；与获得高质量癌症治疗的障碍相关的人群亚组的社会人口特征也可能影响生存期。制定解决生存护理差异的政策和计划并不简单，研究经济困难如何影响癌症结果、减少护理的经济障碍以及增加以患者为中心策略的纳入可能是重要组成部分。同样，关于解决这些差异的最佳策略也几乎没有证据。提供高质量的、以患者为中心的生存护理的障碍包括缺乏证据、缺乏训练有素的生存护理人员、缺乏报销结构/保险覆盖以及缺乏减少分散护理的医疗保健系统。未来的研究需要专注于建立生存护理证据基础、探索促进提供生存护理的策略以及向不同和国际受众传播最佳生存护理实践。
